About this series: Best Practices commissioned Jay Fitch to write a 12-part series on how EMS agencies and fire departments can adapt to the extreme pressures to operate more efficiently while exploring entirely new paradigms of how prehospital care can be delivered. He uses the concepts of organizational agility to provide a blueprint for the “strategic management of uncertainty.” The graphic above shows the four dimensions of organizational agility and the 11 factors that impact agility; each installment of this column will examine a different factor through the prisms of the four dimensions.
Fitch serves on the Best Practices editorial board of advisers and is a founding partner of Fitch & Associates, which has provided strategic and operational consulting services to EMS and the fire service for nearly three decades. To see the previous installments of this series, along with an agility self-assessment tool, visit fitchassoc.com/agility. — Keith Griffiths, editor in chief
I recently observed a multi-victim incident response on an interstate highway. From the hand signals and terse discussions in a difficult location, it quickly became apparent that fire-rescue, medical and law enforcement’s ability to communicate was limited. Communication interoperability is clearly understood in this context. But when discussed in the framework of an organization’s internal need for effective communication, it becomes less clear.
Emergency service agencies are typically organized around functional internal departments that specialize in given tasks. With this approach, work groups erect fences around their duties and build silos of information. They become specialized and territorial and want no overlapping. Each territory or silo needs to be protected by department managers, who may fear for their jobs.
Silos become obvious when different shifts at the same station don’t communicate, when the communications center doesn’t play nice with field operations or when maintenance/logistics doesn’t work well with county purchasing. There are key characteristics and opportunities to reduce silo thinking and improve outcomes that can be gleaned from reviewing cross-functional communication issues through each dimension of agility.
Awareness and alertness
Being alert to “communication ischemia” between individuals, within work groups and between cross-functional teams is like watching a heart attack evolve. Sometimes it’s dramatic, but more often, seemingly insignificant warning signs occur.
In agile organizations, leaders are alert to early signs that communication and interoperability between work teams are becoming constricted. Early symptoms of narrowing cross-functional teamwork can include ambiguity around direction and organizational priorities, excessive analysis, discussions and decisions that are routinely revisited, low trust and strained interpersonal relationships. If left unaddressed, these symptoms encourage the silo mentality and further constrict communication, which is the lifeblood of any organization. Agile organizations pay attention to those early signs and practice “preventive medicine” to enhance communication up, down and throughout the organization.
Leadership orientation
Skillful and consistent communication from leadership is essential in times of uncertainty. While many leaders agree, not all are sure how to go about practicing this type of personal communication. At worst, leaders become living examples of communication barriers; at their best, leaders model clarity, trust and accountability by their communication style.
Skillful communication can be exemplified by listening well, sharing appropriate and timely information, recognizing perception and interpretation differences, and picking up on nonverbal cues when meeting face to face. Agile leaders are willing to engage in difficult and important conversations to achieve positive outcomes; they also welcome upward communication. When caregivers and management take responsibility for communicating new ideas, innovations and better ways to get the work accomplished, agile leaders are receptive and use those opportunities to build even stronger relationships and outcomes.
High-value processes and structures
Agile organizations use data to develop and communicate information across departments and functions to achieve organization-wide results. In fragile organizations, department heads become information gatekeepers who guard “their” data. This makes timely coordination and communication among departments difficult. When gatekeepers create their own nonintegrated mini-data systems (think dispatch, HR, scheduling or billing), it makes it difficult to see the big picture.
There is a story about a large EMS system that was struggling a few years ago to keep its fleet on the road due to a diesel engine issue. Maintenance personnel knew the issue and solution, but because the agency’s communication processes were fragile, the city purchasing department ended up buying additional vehicles to solve the problem. You guessed it: They bought new vehicles with the exact same engine. While I don’t know if this story is true, it makes the point!
One essential aspect of improving cross-functional communication is managing the natural conflict that may arise when team members have different values, attitudes, expectations, roles and responsibilities. Fragile leaders view conflict negatively and avoid it. In this environment, back-channel politics and personal attacks thrive, and team members talk about each other. In contrast, agile leaders “mine” for conflict, extracting and encouraging all team members’ ideas. Team members talk to rather than about each other. Agile leaders will proactively name critical issues, putting them on the table for open discussion.
Development of a performance-based culture
A performance-based communication culture institutionalizes the disassembly of silos. Doing so ensures that the organization’s goals are primary rather than those of a section, department or individual supervisor. It reduces internal competition and enhances cooperation, collaboration and process transparency.
The culture in agile organizations encourages members to discuss and challenge business practices, values and work processes. Through cross-functional conversations, the agency discovers ways to improve system-wide adaptability, optimize internal systems, implement meaningful change and measure the impact.
This component can be summarized by a quote from John Powell, composer of the scores for The Bourne Identity and 50 other films, who said: “Communications works best for those who work at it.” Agile organizations work at cross-functional communication creatively and consistently.
Stay tuned next issue, when we’ll tackle fiscal stewardship.
Kudos to PULSE
An example of excellent cross-functional communication is the PULSE Process pioneered in Pinellas County, Fla. PULSE brings supervisors from multiple internal departments together on a daily basis to review performance and causative factors and to make improvement decisions. Throughout the organization, work processes must be designed to share meaningful information that can be rapidly used to improve results.
